Memorial Hermann’s team of affiliated pancreatic cancer specialists, including oncologists, surgeons and gastroenterologists, provides advanced, personalized care for patients diagnosed with pancreatic cancer. Working hand in hand, these specialists employ the latest therapies and surgical techniques to help patients achieve positive outcomes.

Our experienced oncology nurse navigators help our patients navigate their cancer journeys, as seamlessly and comfortably as possible. And through our cancer survivorship and wellness programs, cancer survivors receive the education and emotional support they need, for life. 

Pancreatic Cancer Statistics

According to the American Cancer Society (ACS), pancreatic cancer accounts for about 3% of all cancers in the United States and about 7% of all cancer deaths, making it the fourth leading cause of cancer death in the United States.

The ACS uses data from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer. The SEER database tracks five-year relative survival rates for pancreatic cancer based on how far the cancer has spread, categorizing pancreatic cancers as localized, regional or distant, with distant being the most advanced.

For localized cancers, the five-year relative survival is 44%, for regional it is 16% and for distant it is 3%. The five-year survival rate for all SEER pancreatic stages combined is 13%, the lowest survival rate for all major cancers.

Types of Pancreatic Cancer

Pancreatic cancer starts in the pancreas, a small, tadpole-shaped organ located behind the stomach that plays an important role in digestion and blood sugar regulation.

The vast majority (95%) of pancreatic cancers are called exocrine cancers (also known as pancreatic adenocarcinomas), which usually start in the ducts of the pancreas.

Risk Factors for Pancreatic Cancer

Smoking (estimated to be the cause of about 25% of pancreatic cancers), being overweight, diabetes, chronic pancreatitis (long-term inflammation of the pancreas) and workplace exposure to certain chemicals are some of the more significant risk factors for developing pancreatic cancer.

Being older, male or African American can increase your risk, as can inherited genetic syndromes (inherited gene mutations, passed from parent to child).

Pancreatic Cancer Stages

If you are diagnosed with pancreatic cancer, your doctors will work to determine if the cancer has spread, or metastasized, to other parts of your body through a process known as staging. Stages of pancreatic cancer range from stage 0 (the earliest/lowest stage of pancreatic cancer) to stage IV (the highest/most advanced stage).

The system most often used for pancreatic cancer staging is the American Joint Committee on Cancer (AJCC) TNM system, which incorporates three factors:

  • Tumor(T): What is the size of the tumor, and has it grown outside pancreas to surrounding blood vessels?
  • Nodes(N): Has the cancer spread to nearby lymph nodes, and if so, to how many nodes?
  • Metastasized(M): Has the cancer spread (metastasized) to distant lymph nodes or distant organs, such as the lungs, bones, liver, or peritoneum (lining of the abdominal cavity)?

Through the staging process, numbers or letters are assigned to T, N and M to denote how advanced the cancer is. As noted above, the higher the number, the more advanced the cancer.

Cancer staging is complex. You doctor can walk you through your specific stage, explaining all of the factors on which your stage was based.

While the TNM system indicates how far the cancer has spread, when determining how to treat a cancer, doctors categorize pancreatic cancers based on how likely the cancer can be removed through surgery:

  • If a pancreatic tumor is only in the pancreas or has spread just beyond it, and a surgeon believes the entire tumor can be removed, the tumor is considered resectable.
  • If a pancreatic tumor is touching nearby blood vessels, but the surgeon believes that the tumor, after being treated with chemotherapy and/or a combination of chemotherapy and radiation, can be completely surgically removed, it may be considered borderline resectable.
  • Unresectable tumors are those that cannot be removed entirely by surgery.

Detection and Diagnosis

One of the reasons pancreatic cancer has such a low survival rate is that symptoms typically do not occur in the early stages, so the majority of pancreatic cancers are diagnosed at a late stage. Fortunately, several studies are underway to search for screening tests for early detection.

To diagnose pancreatic cancer, your doctor may use one or more of the following tests:

Treatment Options

Treatment options for pancreatic cancer include chemotherapy, radiation therapy, surgery, targeted therapy, immunotherapy and ablation, or some combination of these. Your team will create a personalized treatment plan for you based on several factors, including whether or not the cancer can be surgically removed (resected), which is possible in approximately 20% of cases.

Surgery

When pancreatic cancer is localized, meaning it is either confined to the pancreas or spread only to nearby areas, surgery may be performed in an attempt to completely remove the tumor. Doctors must do their best to decide before surgery whether there is a good chance the cancer can be completely removed. Surgeons usually consider an exocrine pancreatic cancer completely removable by surgery if it is staged as T1, T2 or T3. That means it doesn't extend far beyond the pancreas, especially into nearby large blood vessels (T4).

The most common surgery to remove tumors in the pancreas is the Whipple procedure, also known as a pancreaticoduodenectomy. The Whipple procedure is a long and complex operation during which the surgeon removes and reconstructs a large portion of the patient’s gastrointestinal tract, including the head of the pancreas, the first part of the small intestine (the duodenum), the gallbladder, the bile duct and surrounding lymph nodes. If the cancer has invaded into to nearby blood vessels, the surgeon may perform a procedure called vascular reconstruction to reroute the affected blood vessels. In select cases, the operation may be performed through a minimally invasive approach, with the surgeon utilizing a surgical robot. The minimally invasive approach often reduces the patient’s pain after surgery and shortens the patient’s hospital stay.

In cases where the cancer cannot be completely removed, palliative surgery may be performed in an attempt to relieve a patient's symptoms.

Chemotherapy

Chemotherapy is the standard treatment for locally advanced cancers of the pancreas—cases in which the tumor has grown into nearby blood vessels and other tissues but has not spread to the liver or distant organs. Depending on a patient’s diagnosis, one chemotherapy medication or a mix of chemotherapy medications may be used.

Chemotherapy may be used prior to surgery to shrink a tumor enough to allow it to be removed completely with surgery. Even if the cancer doesn’t shrink enough to be surgically removed, chemotherapy may help some patients live longer. The treatment may also be used to prevent cancer recurrence.

Giving chemotherapy and radiation together (called chemoradiation) may be more effective in shrinking the cancer, but this combination has more side effects and can be harder for a patient to tolerate than either treatment alone.

Radiation Therapy

According to the American Cancer Society, more than half of all people undergoing cancer treatment will receive some form of radiation therapy. Radiation therapy is used to cure or shrink early-stage cancer, to stop cancer from recurring, to treat symptoms caused by advanced cancer and to treat cancer that has recurred

Radiation therapy uses high-energy particles or waves, such as X-rays, gamma rays, electron beams or protons, to destroy or damage cancer cells. Cancer cells have an increased sensitivity to DNA damage compared to healthy cells, so the goal of radiation therapy is to injure or destroy cancer cells by damaging their DNA, making it impossible for the cells to continue to divide and spread.

Although radiation can damage normal cells as well as cancer cells, doses are calculated to minimize exposure to surrounding tissue. If normal cells are impacted, your body will work to repair these normal cells and tissues over time.

To increase the likelihood of a positive outcome, radiation therapy may be paired with other cancer treatments, including surgery, chemotherapy, targeted therapy or immunotherapy.

Targeted Therapy

Medical oncologists affiliated with Memorial Hermann are testing individual patients’ cancer genomic information to treat pancreatic cancer more precisely and effectively. With this information in hand, they can prescribe targeted drugs that have been developed to specifically target the changes in pancreatic cancer cells that help them grow. These new drugs can work when standard chemotherapy drugs don’t, and they differ in side effects from chemotherapy.

Immunotherapy

Medical oncologists affiliated with Memorial Hermann are also employing immunotherapy to treat certain types of pancreatic cancer. Once a patient is diagnosed with pancreatic cancer, additional testing is done on pancreatic cancer cells to see if the patient can receive immunotherapy. Immunotherapy drugs stimulate a person’s own immune system to destroy cancer cells.

These drugs may be administered to patients whose cancer cannot be surgically removed, patients who are unable to tolerate chemotherapy, patients whose cancer has recurred after treatment or patients whose cancer has spread (metastasized) to other parts of their body. The side effects of immunotherapy can vary, but in general, immunotherapy is well tolerated by patients.

Ablation

One of the reasons the survival rate of pancreatic cancer remains low is because of its poor response to current chemotherapies. Memorial Hermann is a site for an ongoing clinical trial to test a new procedure known as endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA), which involves targeting pancreatic tumors with heat. During the treatment, a needle, guided visually by ultrasound, is threaded into the tumor, and extreme heat is delivered directly to the cancer cells. This focused heat results in pancreatic cancer cell death; however, the surrounding tissue remains unharmed.

The radiofrequency ablation is paired with chemotherapy to optimize survivability in patients with pancreatic cancer. When the pancreatic cancer cells die, they release fragments of dead cancer that can now be recognized by the immune system. With the treatment, researchers have seen that in addition to destroying the cancer cells in the tumor, the treatment also activates the body’s immune system to seek out and kill any remaining cancer cells. While this treatment is still under clinical trial, affiliated physicians at Memorial Hermann have treated many patients with promising results.

Why Choose Memorial Hermann for Treatment?

Memorial Hermann Cancer Centers are accredited by the American College of Surgeons’ (ACoS) Commission on Cancer (CoC). This rare distinction is given to cancer programs that uphold the highest standard of care for patients. When you choose Memorial Hermann Cancer Centers for your cancer treatment, you can rest assured you will receive the best possible care delivered by a compassionate team of caregivers in a calm, healing environment.

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